Percentage of long-term care home residents whose mood from symptoms of depression worsened

Percentage of long-term care home residents who suffered increased symptoms of depression

Percentage

The indicator is calculated using 4 rolling quarters of data by summing the number of residents that meet the inclusion criteria for the target quarter and each of the previous 3 fiscal quarters. This is done for both the numerator and denominator. The unadjusted value is the quotient of the summed numerator divided by the summed denominator, multiplied by 100 to get the percentage.

Number of LTC home residents in a fiscal quarter with a higher Depression Rating Scale (DRS) score on their target Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessment than on their previous assessment 

Inclusions: 

DRS_cc - Prev_DRS_cc > 0 

Where, 

DRS_cc = DRS score at target assessment 

Prev_DRS_cc = DRS score at prior assessment 

The DRS scale is a measure of a resident’s depressive symptoms, with higher values indicating the resident has more numerous and/or frequent symptoms [0,1,2,…,14]. Depressive symptoms are based on the following variables:

• Resident makes negative statements (E1a)
• Persistent anger with self/others (E1d)
• Expression of unrealistic fears (E1f)
• Repetitive health complaints (E1h)
• Repetitive anxious complaints/concerns (E1i)
• Sad/pained/worried facial expressions (E1l)
• Crying/tearfulness (E1m)

Where,
Each variable is scored according to the symptom frequency in last 30 days:
0 = Not exhibited in last 30 days 
1 = Exhibited up to 5 days a week 
2 = Exhibited daily or almost daily (6 or 7 days)

Number of LTC home residents in a fiscal quarter with 2 valid RAI-MDS assessments whose depression symptoms could worsen (i.e., excludes residents who had a maximum DRS score on their previous assessment) 

Inclusions:

LTC home residents with 2 valid resident assessments within consecutive quarters. The assessment selected as the "target" assessment in the current quarter must: 

• Be the latest assessment in the quarter
• Be carried out more than 92 days after the admission date
• Not be an admission full assessment
• Be from a resident that had an assessment in the previous quarter
• Have 45 to 165 days between the target assessment and assessment in the previous quarter (note: If there are multiple assessments from the previous quarter that meet the time period criteria, the latest assessment is selected as the "prior" assessment)

 

Exclusions: 

1. Residents whose depression symptoms could not worsen (i.e., had a maximum DRS score of 14 on prior assessment (Prev_DRS_cc = 14))
2. Residents who were comatose (B1 = 1)

This indicator is risk adjusted at the individual covariate level and through direct standardization

 

Individual covariates:

• Age younger than 65 years

Direct standardization:

• Case Mix Index (CMI)*

*The relative resource use compared to the overall average resource use for all Ontario LTC home residents 

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Rurality, Time

Includes only residents in long-stay beds. Rolling 4 quarter averages stabilize the rates from quarter-to-quarter variations, especially for smaller facilities, but make it more difficult to detect quarterly changes. Risk-adjusted values are censored if the denominator is less than 30. General limitations when using RAI-MDS data, including random error, coding errors, and missing values. The indicator calculation is based on the Depression Rating Scale (DRS), and measures an increase in the number and frequency of symptoms of depression. The indicator does not measure a clinical diagnosis of depression. The DRS has low correlation with the Geriatric Depression Scale (GDS) as well as with other instruments. [1,2] DRS is limited by a larger floor effect than the Geriatric Depression Scale (GDS). [3] In a 2013 study, the DRS was shown to be poor at distinguishing between older adults with and without a medical diagnosis of depression or between older adults who were or were not prescribed antidepressant medications. [4] Results for fiscal year 2020/21 should be interpreted with caution as the COVID-19 pandemic may have affected data collection. In Ontario, some LTC facilities were unable to complete and/or submit assessments. As a result, CIHI received fewer assessments during the pandemic than in previous years. Additionally, some facilities experienced a decline in admissions. The impact of COVID-19 on the data received by CIHI varies by jurisdiction. Readers are encouraged to interpret results, including comparisons and trends over time, with caution.

Data are based on information from mandatory Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessments. The RAI-MDS is a standardized assessment that is completed for each resident upon admission to LTC and quarterly thereafter by the resident's care team by reviewing the resident's medical records and speaking to the resident and their family.

[1] Anderson, RL, Buckwalter, KC, Buchanan, RJ, Maas ML and Imhof, SL. (2003). Validity and reliability of the Minimum Data Set Depression Rating Scale (MDSDRS) for older adults in nursing homes. Age Ageing 32(4):435-8. [2] Hendrix CC, Sakauye KM, Karabatsos G, Daigle D. (2003). The use of the Minimum Data Set to identify depression in the elderly. J Am Med Dir Assoc.4:308–312 [3] Koehler M, Rabinowitz T, Hirdes J, Stones M, Carpenter GI, Fries BE, Morris JN, and Jones RN. (2005). Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr 5:1. [4] Byma, EA, Given, CW, and Given, BA. (2013). Associations Among Indicators of Depression in Medicaid-Eligible Community-Dwelling Older Adults. The Gerontologist 53 (4): 608-617.

25/02/2022 08:59:00